THE NEW ENGLAND JOURNAL OF MEDICINE, Volume 337, page
568,
August 21, 1997.

Correspondence

Lidocaine-Prilocaine Cream for Pain during
Circumcision

To the Editor: The study by Taddio et al. (April 24
issue)1 raises several troubling
questions. First, if neonatal circumcision is not undertaken
for medical reasons, is it ethical to conduct medical
research on it? In the vast majority of cases, circumcision
is done for religious or cultural reasons. The Canadian
Paediatric Society reviewed the literature extensively and
concluded that any small medical benefits do not outweigh the
risks and that neonatal circumcision should not be routinely
performed.2 Moreover, neonatal
circumcision is done without the consent of the subject,
removes healthy tissue with a unique anatomical structure and
function, and leads to differences is adult sexual
behavior.3

Circumcision can be deeply connected with religious
belief, and any interference with this requires profound
consideration and justification. We need, therefore, to
address the issue directly and end the persistent effort to
find a medical rationale for circumcision by removing the
cloak of medicine from this procedure. Should nonmedical
infant circumcision or research involving it be carried out,
and if so, should it be conducted by physicians, and under
what conditions?

Second, assuming that is was ethically acceptable for
Taddio et al. to undertake this study, was it ethical for
them to include in it a group of infants circumcised without
anesthesia? Generally accepted principles governing the
ethics of research require clinical equipoise4 – that is, before a randomized
trial can be undertaken, the generally accepted medical
opinion must be that no one treatment is superior to another,
and the researchers must share this opinion. In this case,
was there clinical equipoise at the outset of the study?